Volume 3 Issue 4 Article 7

2019

Accommodation Use by Individuals with in Occupational Therapy Fieldwork

Rebecca Ozelie Rush University

Megan Delehoy Rush University

Sierra Jones Rush University

Erin Sykstus Rush University

Victoria Weil Rush University

Follow this and additional works at: https://encompass.eku.edu/jote

Part of the Occupational Therapy Commons

Recommended Citation Ozelie, R., Delehoy, M., Jones, S., Sykstus, E., & Weil, V. (2019). Accommodation Use by Individuals with Disabilities in Occupational Therapy Fieldwork. Journal of Occupational Therapy Education, 3 (4). https://doi.org/10.26681/jote.2019.030407

This Original Research is brought to you for free and open access by the Journals at Encompass. It has been accepted for inclusion in Journal of Occupational Therapy Education by an authorized editor of Encompass. For more information, please contact [email protected]. Accommodation Use by Individuals with Disabilities in Occupational Therapy Fieldwork

Abstract The number of individuals enrolling in postsecondary education with a diagnosed is rising. However, the literature reflects a gap between mandated institutional policies and the extent of accommodation use and success. This study examines the use, type, and prevalence of accommodations used by students with disabilities completing occupational therapy fieldwork otations,r as well as the common barriers to accommodation access. Snowball sampling methodology was utilized to send out a 26-item questionnaire to occupational therapists and occupational therapy assistants. Two hundred and ninety-two occupational therapists and occupational therapy assistants answered the questionnaire to identify disability type, disclosure of disabilities, and types of accommodations used during fieldwork. Results indicated that 47 respondents (16.91%) reported having either a visible and/or invisible disability but of those respondents, only 25 (55.56%) disclosed their disability during postsecondary education. Of the respondents who identified having a disability during fieldwork, 22 (51.16%) perceived that their disability presented challenges, while only 17 (38.64%) requested accommodations. As more than half of respondents felt their disability presented challenges during their fieldwork, strategies are suggested to encourage students to feel more comfortable disclosing their disability. Through creating a culture of openness to disabilities and understanding individual student needs, there is a potential to help increase the rate of disclosure of disability and potentially decrease some of the challenges experienced by students with disabilities on fieldwork. urF ther research is needed to develop guidelines and programming for fieldwork educators on how to best incorporate accommodations into their programs.

Keywords Fieldwork, accommodations, students with disabilities

Creative Commons License

This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

Acknowledgements The authors would like to acknowledge Laura VanPuymbrouck, PhD, OTR/L, Marie Ferro-Lusk, MBA, MSW, LSW, and Lauren Little, PhD, OTR/L, for their thoughtful discussion and contribution to the manuscript.

This original research is available in Journal of Occupational Therapy Education: https://encompass.eku.edu/jote/ vol3/iss4/7

Volume 3, Issue 4

Accommodation Use by Individuals with Disabilities in Occupational Therapy Fieldwork

Rebecca Ozelie, DHS, OTR/L Megan Delehoy, Sierra Jones, Erin Sykstus, and Victoria Weil Rush University, Chicago United States

ABSTRACT The number of individuals enrolling in postsecondary education with a diagnosed disability is rising. However, the literature reflects a gap between mandated institutional policies and the extent of accommodation use and success. This study examines the use, type, and prevalence of accommodations used by students with disabilities completing occupational therapy fieldwork rotations, as well as the common barriers to accommodation access. Snowball sampling methodology was utilized to send out a 26- item questionnaire to occupational therapists and occupational therapy assistants. Two hundred and ninety-two occupational therapists and occupational therapy assistants answered the questionnaire to identify disability type, disclosure of disabilities, and types of accommodations used during fieldwork. Results indicated that 47 respondents (16.91%) reported having either a visible and/or invisible disability but of those respondents, only 25 (55.56%) disclosed their disability during postsecondary education. Of the respondents who identified having a disability during fieldwork, 22 (51.16%) perceived that their disability presented challenges, while only 17 (38.64%) requested accommodations. As more than half of respondents felt their disability presented challenges during their fieldwork, strategies are suggested to encourage students to feel more comfortable disclosing their disability. Through creating a culture of openness to disabilities and understanding individual student needs, there is a potential to help increase the rate of disclosure of disability and potentially decrease some of the challenges experienced by students with disabilities on fieldwork. Further research is needed to develop guidelines and programming for fieldwork educators on how to best incorporate accommodations into their programs.

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LITERATURE REVIEW The number of graduate students with disabilities enrolled in postsecondary education is increasing (U.S. Department of Education, National Center for Education Statistics, 2019). The National Center for Education Statistics (2019), in a profile of students in graduate education, reported that 11.9% of post baccalaureate students had some type of disability. The Americans with Disabilities Act Amendments Act (ADAAA; 2008) defines a person with a disability as an individual with a physical and/or mental impairment that limits their ability to engage in one or more major life activity. The literature often categorizes disabilities as being visible or invisible (Grimes, Scevak, Southgate, & Buchanan, 2017; Osborne, 2019; Ysasi, Becton, & Chen, 2018). The Invisible Disabilities Association defines (n.d.a.) invisible disabilities as conditions that limit a person’s ability to participate in activities but cannot be visibly seen by those around them. Visible disabilities, conversely, include all disabilities objectively observed by others (Invisible Disabilities Association, n.d.b).

The increase in students with disabilities in postsecondary education can be partly attributed to the Americans with Disabilities Act of 1990 and Section 504 of the Rehabilitation Act. These pieces of legislation increased the rights of students with disabilities by protecting them against discrimination while also requiring college campuses to be accessible for all (Deckoff-Jones & Duell, 2018). One way to give students equal access to the learning environment is through reasonable accommodations. According to the ADA, reasonable accommodations may include making already established facilities accessible and usable to individuals with disabilities or “job restructuring, part-time or modified work schedules, acquisition or modification of equipment or devices, appropriate adjustment or modifications of examinations, training materials or policies, the provision of qualified readers or interpreters, and other similar accommodations for individuals with disabilities” (U.S. Equal Employment Opportunity Commission, 2008). Schools are required to provide reasonable accommodations for students with disabilities (Deckoff-Jones & Duell, 2018), which can include changes in equipment, techniques, or curriculum (Disabilities, Opportunities, Internetworking, and Technology, 2017). Disability services offices exist in most institutions of higher education (Thompson, 2018), and these disability services may offer individualized support through personalized accommodations; referral information; informing students of services; distribution of materials to students, faculty, and staff; and hosting educational sessions designed to inform and educate students about disabilities. Personalized accommodations are not intended to give students advantages over their peers, to change specific course features, or to decrease academic rigor. Instead, personalized accommodations are designed to ensure that students are given equal opportunities (Disabilities, Opportunities, Internetworking, and Technology, n.d.).

Although students with disabilities are offered services at the institutional level, many students with disabilities continue to face barriers to successful accommodation use. This can result in lower attendance and decreased graduation rates compared to students without disabilities (Marshak, Wieren, Ferrell, Swiss, & Dugan, 2010). Collins and Mowbray (2005) surveyed over 275 schools across the nation regarding perceived https://encompass.eku.edu/jote/vol3/iss4/7 DOI: 10.26681/jote.2019.030407 Ozelie et al.: Accommodation Use and Fieldwork 3

barriers for students with disabilities. The results indicated that students enrolled in higher education reported barriers to accessing disability services which included: fear of disclosing, lack of knowledge by students or faculty of the services, fear of being stigmatized, lack of proper supported educational programs, not seeing themselves as having a disability, insufficient documentation, lack of motivation, funding issues, an inability to manage a full course load, lack of family support, and teachers not believing the students have a disability (Collins & Mowbray, 2005). Furthermore, Marshak et al. (2010) published a case study of 16 students’ experiences of institutional and personal barriers within higher education. Reflected in the case studies were experiences of teachers unwilling to provide reasonable accommodations. The literature demonstrates a potential gap between mandated institutional policies for how students with disabilities access education and the extent to which accommodations are successfully implemented in higher education settings (Jung et al., 2014; Marshak et al., 2010; Sahlen & Lehmann, 2006).

While research has investigated how students in higher education generally use accommodations, there is a lack of research for the unique experiences within clinical degree graduate programs. Health science programs, which include occupational therapy, are often comprised of both a didactic and clinical component of the curriculum, adding an additional challenge for students with disabilities. Didactic components consist of the learning students do within a classroom, while clinical components provide the students with opportunities to practice learned didactic skills in real-world environments. In occupational therapy programs, the clinical component is referred to as fieldwork, which is an integral part of the occupational therapy curriculum. During fieldwork experiences, students learn by treating clients under supervision of a qualified fieldwork educator and are given the opportunity to develop clinical reasoning and skills essential for future practice.

Fieldwork requires a variety of physical, social, cognitive, and emotional skills (Kemp & Crabtree, 2017). Kemp and Crabtree (2017) conducted a study surveying 343 fieldwork educators to determine the skill demands of different practice areas. The study reported that the top five characteristics for successful completion of fieldwork included the ability to modify, change, and compromise; time management; professional behavior; open and clear communication; and the ability to implement constructive criticism. Furthermore, it was reported that various practice areas likely require different types of skills. These different skills are important to consider when Academic Fieldwork Coordinators assist students with choosing a practice area for fieldwork, since some settings may be more conducive to certain students’ needs and abilities than others. As with all students, their unique skills, personalities, setting preference, and other factors are important to consider when making fieldwork placement decisions.

A qualitative study of five participants with invisible disabilities conducted by Velde, Chapin, and Wittman (2005) investigated the perceptions of students with disabilities within occupational therapy programs and their experiences. The researchers reported five themes that demonstrated how students with disabilities coped with the struggles of graduate school. One theme was “Work Around It;” students expressed their need to

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adapt materials to their preferred learning styles while tailoring their school experience to their needs (e.g., sitting in front of the classroom). Additionally, the theme of “Didn’t Want to do this Alone” meant that students built support systems to help navigate school. Another theme was “I’ve always viewed my disability as part of who I am,” which meant that participants agreed that they did not let their disabilities get in the way of their lives since it was only a part of them. Overall, a review of the literature suggested that students with disabilities identified a consistent trend of attitudinal, social, institutional, and physical barriers to academic success (Aquino & Bittinger, 2019; Jung et al., 2014). These themes represent lived experiences for students with disabilities and are invaluable for faculty and students when determining accommodations that would be helpful.

Because stigma from faculty creates feelings of frustration and anger for students, a major concern for students with disabilities is disclosing their disability to faculty (Aquino & Bittinger, 2019). In an article by Kornblau (1995) a common theme determined that students with disabilities also did not disclose their disabilities to fieldwork sites. In turn, not disclosing created a bias at the site that the students were lazy and put them at risk for failing. It was reported from academic fieldwork coordinators that some clinicians felt resentment for not being forewarned about students having disabilities. In accordance with ADA requirements, students have a right not to disclose their disability and, in compliance with the Family Education and Privacy Act of 1974 (FERPA), academic institutions cannot disclose this information without written consent from the student (Parks, 2017). Despite these legal requirements, fieldwork educators often want early communication about accommodation needs in order to facilitate a positive learning experience. Kornblau (1995) discussed the need for clinicians to become familiar with the ADA requirements applicable to fieldwork. This will help clinicians keep an open mind about students with disabilities and encourage open conversations between clinicians and students.

Past studies have evaluated student accommodations and barriers to seeking accommodations in the didactic portion of the curriculum, but none have evaluated students with disabilities and their experiences with the clinical components of an occupational therapy program. Gathering data on students’ experiences will provide insight as to what might prevent disclosing of a disability or what kind of accommodations may be needed. The objective of this study is to determine the use, type, barriers to and prevalence of accommodations used by students with disabilities during fieldwork.

METHODS

Research Design This study used a descriptive, non-experimental exploratory design. This study was granted an exempt status of the affiliated University Institutional Review Board.

https://encompass.eku.edu/jote/vol3/iss4/7 DOI: 10.26681/jote.2019.030407 Ozelie et al.: Accommodation Use and Fieldwork 5

Participants An electronic survey was distributed via SurveyMonkey® to occupational therapists and occupational therapist assistants across the United States who graduated from an accredited occupational therapy or occupational therapy assistant program (SurveyMonkey®, 1999). There were no additional inclusion or exclusion criteria.

Procedure An electronic survey was developed by the research team. The team conducted a pilot test of the survey to establish content validity by means of a panel of four experts in disability rights and education. This panel assisted with consultation and finalization of the survey items. The final survey was electronically distributed using a snowball sampling procedure via SurveyMonkey®. Snowball sampling has been found to help recruit participants with information that they consider private (e.g., having a disability) and increases the pool of participants by respondents identifying potential participants known to current participants (Etikan, Alkassim, & Abubakar, 2016). Email distribution lists maintained by the Department of Occupational Therapy, regional clinical site contacts, and academic listservs were utilized for initial distribution of the survey in spring of 2018. Respondents were then invited to complete the survey and distribute it to occupational therapy colleagues. In the body of the email the purpose of the study and assurance of confidentiality was stated. No identifying information was collected from respondents. A follow-up email was sent three weeks after the initial email to attempt to obtain saturation.

Instrument A pilot survey was developed using current literature to guide the question content. The survey included demographic questions and questions related to personal experiences with disabilities and accommodations. The survey was structured using skip logic, where each question was dependent on the one prior. Questions 1 -6 were demographic questions all respondents answered. Question 7 asked respondents if they identify as having a visible or invisible disability at the time of their entry level occupational therapy education (with definitions of visible/invisible disability included). If the respondent answered “no” that they did not identify as having a disability during the time of their occupational therapy education, the survey ended.

Data Analysis Descriptive statistics were used to summarize data from closed-ended questions. This was completed through the SurveyMonkey® software.

RESULTS A total of 292 respondents from across the United States completed the survey. A majority of those who completed the survey were practicing as occupational therapists, had a Master’s degree, and were female (see Table 1). Out of all respondents, 42 (15.11%) identified as having an invisible disability, none (0%) identified as having a , and five (1.8%) identified as having both an invisible and visible disability (see Table 2). Those who identified as having a disability indicated whether they were diagnosed prior to their entry-level occupational therapy program (n=32,

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71.11%), during their program (n=11, 24.44%), or after their program (n=2, 4.44%). For respondents who identified as having one or more disabilities, further data was collected addressing disclosure and accommodation barriers, supports, and suggestions.

Table 1

Demographics of Survey Respondents Gender n (Total respondents, n=285) Percentage

Female 262 91.93%

Male 20 7.02%

Prefer not to answer 3 1.05%

Educational Program n (Total respondents, n=289) Percentage

Master’s 173 59.86%

Bachelor's 71 24.57%

Associate 35 12.11%

Doctoral 8 2.77%

Other 2 0.69%

Job Title n (Total respondents, n=292) Percentage

Occupational Therapist 251 85.96%

Occupational Therapy 32 10.96% Assistant Other 9 3.08%

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Table 2

Disabilities Represented Among Survey Respondents Condition n (Total respondents, n=47) Percentage

Anxiety Disorder 22 46.81%

Depression 12 25.53%

Migraine Headaches 9 19.15%

Attention Deficit Hyperactivity Disorder 8 17.02%

Learning Disability 7 14.89%

Immune Disorder 3 6.38%

Arthritis 2 4.26%

Diabetes 2 4.26%

Blindness or other visual impairment 1 2.13%

Heart Disease 1 2.13%

Orthopedic Impairment 1 2.13%

Other 7 14.89%

Disclosure Out of those who identified as having a disability, 25 (55.56%) of the respondents chose not to disclose their disability during the course of their time in their entry-level occupational therapy program. Reasons mentioned for not disclosing can be found in Table 3. Those who did decide to disclose their disability during their program most commonly disclosed to their advisor (n=16, 64%). Respondents also chose to disclose to other faculty members (see Table 4).

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Table 3

Reasons for Not Disclosing to Entry-Level Occupational Therapy Program Reason n (Total respondents, n=25) Percentage

Fear of stigmatization 13 52%

Did not feel it would be beneficial to 13 52% educational experience

Fear of discrimination 9 36%

Unaware of potential accommodations 6 24%

Disability was not clinically diagnosed 6 24% at the time

Other 5 20%

Table 4

Disclosure to Faculty Members Faculty Member n (Total respondents, n=25) Percentage

Advisor 16 64%

Course Instructor 15 60%

Academic Fieldwork Coordinator 14 56%

Disability Services 11 44%

Chair or Program Director 9 36%

Academic or Admissions Coordinator 3 12%

Other 2 8%

Accommodations Of all participants disclosing disability, 17 (38.64%) requested accommodations prior to or during their entry-level occupational therapy program. Commonly requested accommodations included extra time for documentation, testing accommodations, quieter workspaces, and more breaks throughout the day (see Table 5). Half of the respondents (n=22, 51.16%) found their disability/disabilities presented challenges while https://encompass.eku.edu/jote/vol3/iss4/7 DOI: 10.26681/jote.2019.030407 Ozelie et al.: Accommodation Use and Fieldwork 9

on fieldwork. The main challenge identified by 15 (68.18%) respondents was mental exhaustion, followed by challenges with written communication, communication with the supervisor, distractibility, physical exhaustion, pain management, social interactions, clinical reasoning, communication with patients, lack of preferred instruction style, time management, and mobility (see Table 6).

When asked about accommodations that could have been beneficial while on fieldwork, respondents who did not request accommodations indicated that more breaks throughout the day (n=3, 50%) and an altered daily schedule (n=2, 33.33%) would have been helpful. A fill-in option allowed respondents to add additional potentially beneficial accommodations. Some of their responses included further fieldwork coordinator support, mentor support, and incorporating computerized documentation with spell check. One respondent also mentioned that having a culture within the fieldwork setting where different ways of doing things are valued would have enhanced the experience.

Table 5

Accommodation Use by Survey Respondents Accommodation n (Total respondents, n=17) Percentage

Extra time for documentation 5 29.41%

Testing accommodations 5 29.41%

Quieter work space 4 23.53%

More breaks throughout day 3 17.65%

Altered daily schedule 2 11.76%

More meeting time with supervisor 2 11.76%

Part-time schedule 1 5.88%

Special lighting 1 5.88%

Other 5 29.41%

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Table 6

Challenges for Survey Respondents during Fieldwork Challenge n (Total respondents, n=22) Percentage

Mental Exhaustion 15 68.18%

Communication with Supervisor 8 36.36%

Written Communication 8 36.36%

Distractibility 7 31.82%

Physical Exhaustion 7 31.82%

Pain Management 5 22.73%

Social Interactions 5 22.73%

Clinical Reasoning 3 13.64%

Communication with Patients 3 13.64%

Lack of Preferred Instruction Style 3 13.64%

Time Management 3 13.64%

Mobility 2 9.09%

Other 2 9.09%

DISCUSSION Our study sought to determine the use, type, barriers to and prevalence of accommodations used by students with disabilities during fieldwork. Many interesting findings were discovered. One such finding was that there were more students with reported invisible disabilities than visible disabilities. This is an important finding to highlight as students with invisible disabilities are found to have a harder time managing school compared to those with visible disabilities (Deckoff-Jones & Duell, 2018). People with invisible disabilities who decide not to disclose may have added stress of hiding their disability to avoid stigmatization. Literature suggests that students with invisible https://encompass.eku.edu/jote/vol3/iss4/7 DOI: 10.26681/jote.2019.030407 Ozelie et al.: Accommodation Use and Fieldwork 11

disabilities are more challenged in their claims of disability and potential impacts on academic performance are not deemed as credible (Jung et al., 2014). Disclosure of a disability is therefore limited due to fear of discrimination against the prejudices and biases of those around them, including those in power that could impact the outcome of their studies. In addition, concealability of visible disabilities is much harder (Akin & Huang, 2019), which could account for decreased number of students with visible disabilities in occupational therapy programs.

Furthermore, this study found that 47 (16.91%) respondents reported having a disability. This is considerably higher than the national average of 11.9% of students with disabilities in post baccalaureate programs (U.S. Department of Education, National Center for Education Statistics, 2019). Considering that the focus of occupational therapy is on participation in meaningful activities and addressing physical, psychosocial, and developmental challenges (AOTA, 2013), it is not surprising that the average number of occupational therapy students within our sample that disclosed having a disability exceeds that of other programs.

According to the survey results, 20 (44.44%) respondents that reported having a disability did not disclose their disability at any point during postsecondary education. The two leading reasons for respondents who chose not to disclose were “fear of stigmatization” and “did not feel it would be beneficial to the education experience.” However, more than half of the respondents (n=22, 51.16%) felt their disability presented challenges during fieldwork experiences. To decrease challenges for these students, the culture around supervising fieldwork students must be examined. In a study by Lew, Cara, and Richardson (2007), interviews were conducted to explore counterproductive events experienced by occupational therapy students during fieldwork placement. The study reported that occupational therapists felt there is a specific way occupational therapy services should be rendered. Due to this inflexibility, students’ individual needs may be ignored. There should be more openness and value on adapting occupational services to include accommodations for students with disabilities. Occupational therapists have a unique knowledge on how to work with people with disabilities and this knowledge should not be limited to their clientele but be expanded to the students they supervise as well (AOTA, 2013).

While 32 (71.11%) students reported the onset of their disability prior to occupational therapy school, 11 (24.44%) reported the onset of their disability occurred during occupational therapy school. Combined with the fact that anxiety was the top invisible disability reported, the stressors of graduate school and rigor of occupational therapy programs may bring to light disabilities students had silently managed or had been undiagnosed with previously. This presents an extra challenge as a student deals with both a new diagnosis and the stressful environment of occupational therapy school and fieldwork.

Of those who reported having a disability during fieldwork, 22 (51.16%) respondents felt their disability presented challenges during fieldwork. The top challenges during fieldwork included mental exhaustion, difficulty communicating with their supervisor, and

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difficulty with written communication. As shown by the results, respondents diagnosed with a disability while on fieldwork expressed additional challenges that could have potentially hindered their ability to complete their fieldwork experience successfully. There are recommended strategies that exist to encourage students to feel more comfortable disclosing their disability.

One recommended strategy is to emphasize streamlined communication between the fieldwork educators and students to discuss what is needed for a successful fieldwork environment. Another strategy for students who need accommodations is the use of the DIALOGUE method, which aims to improve relationships between fieldwork educators and students with disabilities (Kornblau, 1995). Occupational therapists already have the clinical reasoning and activity analysis skills to help students with disabilities succeed. With open communication, the therapist on site can help to implement accommodations for students, and thus increase the likelihood of successful fieldwork (Kornblau, 1995). The DIALOGUE method was developed to comply with ADA regulations (Kornblau, 1995). This method creates guidelines for a successful relationship by using the following protocol: 1. Discuss: ADA laws and regulations. 2. Identify: students that need accommodations. 3. Assess: advantages and disadvantages of disclosing disability to fieldwork site. 4. List: accommodations used in school, and develop ideas for functioning based on job description to find sites where the student will be successful. 5. Open: encourage student to disclose information to site before the experience begins. 6. Go: go to the fieldwork site before their clinical fieldwork begins to discuss accommodations. 7. Undertake: site must accept changes under ADA law. 8. Encourage: encourage open communication throughout the entire process (Kornblau, 1995).

By encouraging open communication between students with disabilities and occupational therapy fieldwork educators there can be a decrease of stress around completing fieldwork. Creating a culture of openness to disabilities, and understanding of individual student needs, there is a potential to help increase the rate of disclosure of disability and thus decrease the challenges experienced by students with disabilities on fieldwork. This survey has helped to identify possible accommodations for occupational therapy students with disabilities. Potential accommodations are outlined in Table 7. It is important to note that the fear of stigmatization may limit the number of students that choose to disclose their disability; therefore, education for students, faculty, and fieldwork sites is important to encourage open communication, and hopefully increase the number of students feeling comfortable disclosing their disability.

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Table 7

Strategies for Accommodations for Fieldwork Placements Fieldwork Accommodations How to Implement

Altered daily schedule Arrange daily schedule to meet needs of student while adhering to productivity. Example: Allow student to begin chart reviews at 7 am instead of 8 am to allow for increased prep time at start of day for student with anxiety.

Increased breaks throughout day Schedule sensory breaks throughout day. Example: Include three 10-minutes breaks scheduled throughout the day and extend work day by 30 minutes to accommodate for breaks.

Part-time schedule Engage in early communication between the student, Disability Services Office, faculty, and site coordinator to arrange for the student to complete fieldwork on part time basis. Example: Arrange for 20 hours per week for 24 weeks. Quiet work space to document Create or find a quiet space for the student to complete documentation in to minimize distractions and maximize concentration. Example: hospital library or chapel, unused office space, etc.

Extra time for documentation Allow the student to come in earlier or stay later than the regularly scheduled work hours to complete documentation. Depending on facility policies, the supervisor may not need to stay during this extra time.

Physical environmental Allow for to spaces with different kinds of modifications lighting, ergonomic seating, technology, and other materials.

Education for faculty and students related to disability awareness and examples of proper accommodations can help to improve sensitivity and increase communication (Meeks & Jain, 2018). According to a study completed by Lew et al. (2007), the primary factor contributing to dissatisfaction with students’ fieldwork experiences was poor supervisor educational techniques and characteristics. The authors found that supervisors had little knowledge about creating accommodations for students to

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enhance a successful work environment and recommended that further solutions should be developed to minimize difficulties in fieldwork for students who may need accommodations (Lew et al., 2007).

It has been suggested in the literature that students that identify as having a disability during their clinical education hold a disability identity that will inform their clinical practice and lead to culturally competent care (lezzoni, 2016). Students with disabilities can provide a unique perspective to the occupational therapy relationship (Velde et al., 2005). Since they have firsthand experience with living with a disability, they can be more sympathetic towards their future patients (Velde et al., 2005). Therapists with disabilities can also bridge the divide between therapist and patient since they can relate to the shared (Chacala, Mccormack, Collins, & Beagan, 2014). Clinical components of an occupational therapy curriculum can be challenging for students with disabilities and fieldwork sites can be unprepared to provide appropriate accommodations (Hirneth & Mackenzie, 2004). However, occupational therapists have the unique skill set to accommodate students with disabilities (AOTA, 2013) and thereby powerfully impact clinical care for those clients that students with disabilities will serve in the future.

The accommodations respondents identified as utilizing the most and implementing successfully throughout their fieldwork placement included extra time for documentation, testing accommodations, quieter workspaces, and more breaks throughout the day. Importantly, respondents identified further accommodations they believed would have been beneficial during fieldwork. These included an “altered daily schedule” and “more breaks throughout the day.” These findings create an opportunity to explore ways to implement change to support students with disabilities in becoming practitioners (see Table 7). Ensuring an adequate and diverse workforce is a crucial part of the AOTA’s Vision 2025 (2017). By making the profession more accessible to future practitioners, it will be possible to work toward the diversity and cultural responsiveness goals of the AOTA (2017).

Recommendations for Future Research Further work is needed to develop guidelines and education for fieldwork educators on how to best incorporate accommodations into their programs. It is also recommended that supplemental surveys to fieldwork educators who have worked with students with disabilities be distributed to provide a more holistic perspective of the impact of accommodations. The incorporation of focus groups that include both individuals with disabilities and fieldwork educators is another way to discover more about the topic. Furthermore, an evaluation of the effectiveness of granted accommodations is recommended.

Limitations Although this research was executed carefully, there were some limitations to this study. The number of recipients reached by the survey is unclear due to the use of snowball sampling methodology. The survey was also only disseminated via email which may have impacted the total sample size and participant demographics. The format of the https://encompass.eku.edu/jote/vol3/iss4/7 DOI: 10.26681/jote.2019.030407 Ozelie et al.: Accommodation Use and Fieldwork 15

survey, by grouping all responses for each question, hindered our ability to parse out and analyze the data of individuals to understand their unique successive answers throughout the survey.

Implications for Occupational Therapy Practice  There is an increased prevalence of students with disabilities completing fieldwork placements. A lack of disclosure and implementation of accommodations for students with disabilities can cause challenges while on fieldwork.  Occupational Therapy programs should strive to normalize help-seeking behaviors by students with disabilities. This may reduce the stigma many students are fearful about as they consider disclosing their disability and need for accommodations.  An environment of open communication about accommodations for students with disabilities between fieldwork educators and students can ensure a smoother transition from classroom to clinic.  Increased publicized disability resources for occupational therapy students should be available to encourage more students with disabilities to enter the profession. Students with disabilities can provide a unique perspective to the occupational therapy relationship and provide culturally competent care to those they serve.

CONCLUSION With the increase of students with disabilities enrolling in postsecondary education and individuals still identifying as being too fearful to disclose their disability to administrators, it is necessary that further work is done to develop guidelines and education for fieldwork educators on how to best incorporate successful accommodations into fieldwork. Education should be provided to faculty and students about accommodations and the need to disclose to promote a smoother transition from the didactic coursework into fieldwork. With the unique experience of fieldwork, it is important to further study the accommodations used during fieldwork placements. While students are not required to disclose, strategies must be used in order to help open communication between students with disabilities and fieldwork sites in order to get students the accommodations they need and deserve. By focusing on open communication and keeping a dialogue of the accommodations that students may need, fieldwork educators and students with disabilities can ensure a smoother transition from classroom to clinic. Since these students have a unique perspective about having a disability, students with disabilities can be instrumental in bridging the gap between therapists and patients with providing insight into the lived experience of having a disability.

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https://encompass.eku.edu/jote/vol3/iss4/7 DOI: 10.26681/jote.2019.030407